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General NPI Number Information
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NPI Number | 1396721494
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Entity Type | Organization
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Legal Business Name | MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA
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Dates
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Enumeration Date | 12/20/2005
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Last Update Date | 05/08/2008
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Provider Practice Location Address
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Address Line | 501 S 54TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19143-1900
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Country | US
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Telephone | 215-748-9707
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Fax | 215-748-9708
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Provider Business Mailing Address
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Address Line | 1 W ELM ST 2ND FLOOR
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City | CONSHOHOCKEN
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State | PA
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Zip | 19428-2007
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Country | US
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Telephone | 610-567-6964
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Fax | 610-567-6170
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Authorized Official
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Title or Position | VP FINANCIAL SERVICES
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Name | MR. DOUGLAS C SMITH
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Credential |
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Telephone | 610-567-6964
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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